Lesson Plan—Coaching Session #1

Staying Healthy Through Education and Prevention (STEP)

Welcome to the STEP Physical Activity Program

Introduction

The purpose of this session is to introduce participants to their STEP program leader, to fellow participants, and to the STEP program. Coaching Session 1 sets the stage for the success and impact of the STEP coaching sessions.

Preparation

To assist with your discussion and explanation of the FITT Principle and the Rate of Perceived Exertion (RPE) scale, go to Chapter 6, consider creating large posters or charts with the key information.

Prepare folders for each participant to keep track of their session handouts.

Print Session #1 handouts for each participant.

Session Objectives

In this session, participants will:

Meet the staff member in his/her role as the behavior/activity coordinator.

Session Content and Sample Scripts

I. Welcome and Introduction

Greet participants in an enthusiastic and friendly manner.

The most important part of this session is to establish a good relationship with participants and to convey enthusiasm for the STEP program. Encourage the participants to ask questions and express concerns. This session should be conversational rather than didactic.

Use open-ended questions to facilitate participants speaking freely.

After you have introduced yourself and talked about your background and role in the STEP program, begin by covering the following:

SCRIPT:

Welcome to the Step Program!

I want to welcome you to the STEP program, which is designed to help you all become healthier and more active people. The program is based on the latest research in physical activity and behavior change. It will give you the tools that you need in order to learn new, positive behaviors and to identify and change negative behaviors. It will help you develop an active lifestyle and teach you to maintain your new activity levels, in the program or on your own. You can already take pride in just being here ready to start this exciting new program! You have taken the first, very important step in this process.

Over the next couple of months, we will cover several topics that strongly influence your habits and your activity levels. Overall, I want to equip you with the tools, practice, encouragement, and information you need in order to build your confidence about being more active for the rest of your life.

I would also like to touch on the importance of the dynamics of this group and group participation. We all come from unique backgrounds and have many different experiences to share. That means we each bring something special to the group, which we can use to increase physical activity in our daily lives. How our group interacts will influence the success of this program. Positive group participation is a key component, as we help each other become and stay active.

Together, we will share our successes and our challenges. We will learn problem-solving skills to address our concerns and meet our goals. As a group, we will make this fun and successful for everyone! Are you as ready and excited as I am? Yes? So, let the process of becoming more active begin!

II. STEP Program Overview

Provide a brief overview of the STEP program. Indicate that it is designed to help older adults improve their physical function and prevent physical decline.

Review the structure of the program in Chapter 7, and describe what opportunities you have decided to offer your participants—walking courses, "destination" walking goals, parties, etc. You can also refer participants to the Session 1 handout "Overview of STEP Physical Activity Program" during your discussion to help introduce STEP.

SCRIPT:

Let me start by describing the basics of STEP. Our main goal is to build up to 150 minutes of exercise every week. That may sound huge right now, but if you think about it, when you get to that goal, it is less than 30 minutes a day. And you won't be doing the same exercise over and over again, either. STEP is a combination of aerobic exercise, to get your heart rate up; strength classes to keep your muscles strong; and balance and flexibility activities to keep you moving around easily. I'll talk about each of those activities in detail in a minute. Does anyone have any questions so far?

[Answer any questions that come up and if people ask questions that you'll cover later, don't feel shy about telling them so.]

Okay, great questions. I should also mention that the Surgeon General recommends moderate physical activity for 30 minutes on most, if not all, days of the week. STEP was designed with this public health recommendation in mind and was designed specifically for your age group, your needs, and your health.

Now let me tell you about the walking portion of the program.

Walking: Walking will be your main source of aerobic exercise, in addition to the group classes. We want you to walk regularly, by yourself, with a partner, or in a group. We strongly encourage you to set up a small walking group. It's easier to stay motivated when you're accountable to someone else, and I hope you'll enjoy the social aspects of these walks too. You can walk outside or inside [if you have set up a walking course or have a pool available, describe those options now]. When you exercise, make sure it is "dedicated" exercise. As in, you have put on your walking shoes and decided to go walking. Short episodes of physical activity are great for you too, like walking to the dining room, but they shouldn't be counted toward your total walking time. Over time I want you all to dedicate time specifically for exercise, and I will teach you how to do this. During the first 9 weeks of the program, we will work up to a goal of 150 minutes of total exercise each week. That is, the time in strength classes plus walking time will build up until you reach 150 minutes of exercise each week. You will have a physical activity log that you will use to record the time you spent walking. If you look at your handouts, you will see a chart marked "Overview of STEP Program." You'll see that your walking starts at 30 minutes each week and increases week by week.

Group-Based Strength Training Classes: The second important part of STEP is strength training. We will meet as a group for strength training at least once a week. We'll work toward a goal of attending strength training classes at least twice a week. In the first 9 weeks of the program, these classes will include behavior coaching sessions. The behavior coaching sessions are designed to help you develop the knowledge and skills to make long-lasting changes in your physical activity levels to improve your health and wellness. We'll talk about things like recognizing and overcoming mental barriers, building a strong support network, and staying motivated. Let me stop again at this point. Does anyone have any questions?

STEP Tracking Log: As I already mentioned, each of you has the option of keeping a log of your exercise—the time you spend in the STEP strength training classes and the time you spend walking. These logs will help you track your progress and meet your individual physical activity goals. We will also be looking at them in class and discussing your goals and activities, so we strongly recommend you each keep a log. Copies of the STEP Tracking Log are included in today's session materials and I will distribute additional blank copies of the form each week. The easiest way to use the form is to enter your times immediately after each STEP class and walk. Again, you don't have to use these tracking sheets, but they are a very easy way for you to help keep track of and celebrate your progress.

Balance Exercises: Starting in the 3rd week of the program, you will receive a handout with several balance exercises you can do at home. Everyone will start at the beginning level of these exercises and move up as they improve. The balance exercises will complement the strength training and walking parts of the program by increasing your flexibility and stretching muscles that might get tight in strength class. You don't have to keep track of balance exercises in your log since they are not strength based or aerobic. You can do them every day or less often (of course, we recommend you do them sometimes!). The balance exercises are just one more thing that can help you feel healthier and more mobile.

Now you know the basics of the STEP Program! Does anyone have any questions before we continue?

III. Personal Goals and Concerns

Engage participants in a discussion of their goals and concerns as they embark on the program.

SCRIPT:

It is very important to discuss personal goals and concerns. What do you want to achieve from being involved in this program? Have you ever tried this type of program before? Did you do it on your own? What happened? Do you have any concerns or questions before you begin the STEP physical activity program?

IV. Staff-Participant Relationship

Introduce the guidelines for establishing a "winning team" with the participants.

Let the participants know they can count on you to help them reach goals, answer questions, be honest, and provide support.

Some participants, because of their cultural heritage or personal history, may consider it rude to ask questions or to bring up difficulties. With these participants in particular, be sure to express your acceptance and appreciation when they voice their questions and concerns.

SCRIPT:

I want to make sure that you achieve your best possible results in our program. You will probably be most successful if you:

Come to all the classes.

Do your best to reach your activity goals.

Let me or someone else know if you have any problems:

Ask questions when you don't understand something. I am here to help and I need to know when you have problems. There is no such thing as a "dumb" question.

It's smart to speak up when you have a question.

Stay willing and open to change. I will help you in any way I can, including:

Reviewing your progress.

Answering your questions. It is important that you feel free to ask me any questions you have, and I will get the answers for you. Please remember that the staff are here to teach skills and assist you in any way we can.

Standing by you when you need me to support your changes.

Believing you can reach your physical goals. We all need someone to believe in us when we are making changes for the better. I know you can do it, and when you get discouraged, I am here to provide feedback.

Is there anything else you would like me to do to help you?

V. The FITT Principle

Discuss the FITT principle with the participants.

Consider using a large poster with the key elements of FITT listed as a discussion aid.

Go through each element of FITT slowly and give examples of each element (frequency, intensity, time, and type), making sure participants understand the distinctions.

SCRIPT:

Now I want to talk with you about something called the FITT principle. We'll use the FITT principle to help monitor how hard we're working during our walking and strength exercises. FITT is an acronym for Frequency, Intensity, Time, and Type. When you exercise, you should pay attention to these four things to get the most effective exercise you can while also staying safe. Let me explain each of these elements (refer to your wall chart, if you made one).

F = FREQUENCY (HOW OFTEN?)

We recommend that you perform the aerobic (walking), strength, and balance activities at least 3 times per week.

You can increase frequency gradually, as tolerated.

I = INTENSITY (HOW HARD?)

You will measure the intensity of your exercise using the Rating of Perceived Exertion (RPE).

You should try to maintain an RPE of 11-13 for aerobic activity, like walking.

For strength training, maintain an RPE of about 15-16.

I'll come back to this idea.

T = TIME (HOW LONG?)

Gradually increase the total number of minutes you exercise based on how you feel. One of your handouts has a chart of the activities we'll be doing. We will start with 30 minutes each week and work our way up.

At the end of 9 weeks, our goal will be about 30-50 minutes of aerobic activity on most days.

You may perform your physical activity in short bouts, such as taking five 10-minute walks, if that suits you better.

T = TYPE (WHAT KIND?)

Perform aerobic activities that use large muscle groups like brisk walking, swimming, or cycling when you aren't in class. The STEP program focuses primarily on this type of exercise.

As you are talking about the RPE Scale, you may find it helpful to have a large version of the RPE Scale on a flip chart or poster in the front of the room.

Key points to discuss about RPE:

Participants should become familiar with their own RPEs for walking and strength training so they can achieve the desired intensity for these activities.

Insufficient RPE may not produce the desired improvement in function, even if the amount of time doing physical activity increases.

Excessive intensity may result in injury and should be avoided.

SCRIPT:

Basic Instruction:

As I mentioned before, Rate of Perceived Exertion, or RPE, is the way you'll monitor the intensity of your activities. This intensity is based on your perception of how hard you're working, or how heavy and strenuous the exercise feels to you. You will want to pay attention to the strain and fatigue in your muscles, any feeling of breathlessness, or other sensations to decide on your rating. But remember, the rating should be based on your subjective feelings and not on the actual physical load—since everyone is different, everyone's reaction to exercise will be different.

"Maximal Exertion," or 20 on the scale, is the strongest exertion you have ever experienced. You should never be anywhere near this point in the STEP program! At the other end of the scale, we have 6, "the absolute minimum," or 7, "very, very light." Exercising at this level of intensity is not likely to benefit you in this program. The idea here is to exercise at a level that is above "light" and below "maximal" so that you are challenging yourself without putting yourself at risk. Let's go through the whole scale together and then start thinking about how strenuous our usual activities are.

Scaling Perceived Exertion:

6 Is the "absolute minimum" effort you can exert.7 Is "very, very light." It is easy and comfortable to do the activity.9 Is "very light," like walking slowly at your own pace for several minutes.11 Is not especially hard; it feels fine, and it is no problem to continue.13 You are tired, but you don't have any great difficulty.15 You can still go on but have to push yourself and you feel very tired.17 You are so tired that you think you cannot continue for much longer.19 This is as hard as you have ever experienced.20 This is the "absolute maximum" effort you can exert.

Think about the act of walking: Where do you usually walk and where are you usually going? Are you relaxed or are you in a hurry? Now think about how hard this walk is for you. Start with a verbal expression of how difficult or intense you find it. (Pause to let people think.) Now look at the scale and choose a number. If your perception of the intensity is "very weak," say 6; if it is "moderate," say 12; and so on. You are welcome to use half values (such as 10.5 or 13.5, or decimals, for example, 9.3 or 7.8). It is very important that you think about what you perceive as your level of exertion with this or other activities, not what you believe you should answer. Be as honest as possible and try not to overestimate or underestimate the intensity. And don't worry. We'll keep practicing.

[Note: If people seem a little confused, feel free to work through a few more examples. Ask the same questions as above to get them thinking, but relate the questions to playing with grandchildren (strenuous for some and not others), reading a book (very low intensity for most), doing chores, etc. This is an important concept, so don't rush through it. If you're running out of class time, be sure to review RPE during the next session.]

VII. Reporting Health Concerns

SCRIPT:

A brief note on safety: As always, we want to respond to any health issues that might affect your ability to engage safely in the STEP program. As you know, the strength classes are always supervised so that we can make sure everyone is using their weights safely. We also have plenty of time during our "behavior coaching" sessions to discuss safety and health concerns. If you have any concerns that you would rather discuss in private, please let someone on the staff know and we can set aside time to talk and work on it with you. If you find yourself exhausted during a strength class, please stop, sit down, and rest. If you think you might be having a more serious health event such as chest pain, please tell us immediately so that we can address it.

VIII. Questions and Wrap-Up

Summarize the material and concepts you covered in the session and provide an opportunity for participants to ask questions and express concerns.

Remind participants of the time and date of the next session and the topic that will be covered.

SCRIPT:

I know we've covered a lot of material today. Do you have any more questions I can answer for you?

Now that you know more about STEP, I want to point out the Participant Agreement to you. This is an informal agreement, not a contract or anything binding. It gives you a brief summary of the program and the expectations we have for people who participate. For example, we expect you to communicate with us about medical issues that might lead us to suggest that you take a break from the program and so we can make sure you all stay safe while participating in the program. Look it over and make sure it sounds reasonable to you, then sign if you feel comfortable.

Our next session is _________________________________________________________. We will be talking about Being Effective Group Members and Motivation.

What I want to do now is give people an opportunity to practice using ankle weights. These are the weights we'll use for some of our exercises. We're not going to do any exercises today. I just want you to get comfortable with how they work. Let me now show you how to put them on [Go to Practice instructions.]

IX. Practice

If you have time, provide an opportunity for participants to get comfortable with the ankle straps and weights they will use for the strength exercises (as described in Chapter 7). Most participants won't have used ankle weights before and may need time to feel sure of themselves.

Teach them how to put the cuffs on and take them off.

Allow them to wear the cuffs without any weight in them to get accustomed to the feel.

When the cuffs are off, allow them to hold the weights in their hands and practice inserting the weights into the cuffs.

You will probably need to find a separate time (outside of strength class or before) to help each participant determine his or her appropriate starting weights. However, it has been our experience that most seniors are comfortable starting with &frac12; to 1&frac12; lbs, with men tending to start with somewhat more weight than women. It is critically important that participants do not "overdo it" with their initial weight selection because they can experience considerable muscle soreness that, although temporary, may cause them to quit the program almost immediately. During the next strength class, you can teach them the exercise movements and discuss monitoring RPE while using ankle weights. Remember that so far you have only discussed walking RPE. Use Chapter 7 as a reference.

SCRIPT:

Ending the Session

It was a pleasure to meet you/see you all here and I look forward to our next session together. Thank you for coming in today. I'm really glad that you are interested in starting the STEP program and I will do everything I can to make it as rewarding as possible for all of you!